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Abstract
In 2019 Oregon Project runner Mary Cain shared her story of abusive coach Alberto Salzar to spread awareness on the toxic culture of female endurance sports. Soon after, athletes across the nation from high schoolers to elite runners have begun to speak on their coaches' painful methods. Eating disorders are at the forefront of issues in female athletics; but, behind closed doors their coaches have been perpetuating even more health problems, physical and mental. A full analysis on the state of coaching for female endurance athletes will help gain awareness on the issue and lead towards solutions for victims. The current coaching culture for young female endurance athletes is dangerous to their health and better education is needed. Runners face dangerous health issues like amenorrhea, RED-S, VCD, and disordered eating. The coaches exacerbate the problem by focusing on athletes' physical appearances, lacking nutritional education, and giving women training volumes the same as men. A starting solution to the situation is more research, having standards set in place for coaches, and increasing the presence of educated female coaches. Note that this is not an issue only in male coaches, but lack of knowledge in all genders about female endurance athletes.
Keywords: Female endurance athletes, RED-S, coaching, running, eating disorders, sports medicine
The Dangerous Coaching Methodologies for Female Endurance Athletes
When Mary Cain broke the internet in 2019 by exposing her abusive elite running coach of the Nike Oregon Project, a series of athletes came forward in a wave familiar to the #metoo movement. These activists began to work towards a new culture in endurance sport. The dangerous coaching methodologies for female endurance athletes has finally been exposed to the media as athletes have suffered behind closed doors for years. In order to better understand the problem an evaluation of the different health issues these athletes face has been presented. As well, the coaching methodologies that perpetuate these problems. These methodologies must be curbed through education and research. It is important that this culture be changed to improve the health and safety of these dedicated athletes.
Common Problems in Female Endurance Athletes
Mary Cain created awareness for a disease previously known as the female triad, now known as relative energy deficiency in sport (RED-S) by the IOC. The disease is one of the many issues female athletes could see from poor training and toxic culture in sport. Issues in breathing function, performance plateaus, and generally losing interest in sport are also common problems. All of which are preventable given proper culture in sport and training methodologies for females, especially of young age.
RED-S is a common disorder in female endurance athletes, but can affect anyone with low caloric intake and high energy output through exercise (Brown University, 2021). It is characterized by severe low energy as well as amenorrhea (in females) and low bone density resulting in issues like stress fractures and osteoporosis. It is common that those who have RED-S have disordered eating habits, whether they are intentional or unintentional (Brown University, 2021). This disease is rarely diagnosed and usually only identified after serious injury, similar to the case of Mary Cain who broke multiple bones during her training. Besides diagnosing RED-S, the warning sign of amneroehaa is the most important for athletes to notice. Any form of menstrual irregularity increases athletes' risk of injury. Amenorrheic athletes have 2 to 4 times greater risk for stress fracture than eumenorrheic (regular menstruation) athletes (Nazem, 2012). As well, women who participate in sports that emphasize leanness, the prevalence of secondary amenorrhea can be as high as 69%, compared to 2-5% in the general population (Nazem, 2012). One pilot study states they found 70% of interviewed female high school runners had menstrual irregularities (Kraus, 2019). Many athletes who are experiencing amenorrhea could not be aware due to taking oral contraceptive pills (OCP). OCPs can cause a restart of menstrual bleeding, giving the athlete a false sense of eumenorrhea, without any change in energy availability (Nazem, 2012). The disease can be tricky in identifying, especially in athletes who believe their symptoms are just a result of “hard work”. The hardest block to discovering the condition is overcoming the psychological component. Athletes are resolute, competitive people, with perfectionist personalities. Changing the mentality of how dangerous training could be on their body is difficult. Solutions besides changes in exercise and diet are merely small fixes to the large problem (Nazem, 2012). The most common drug intervention is OCPs in order to “restore” menstruation or provide adequate hormonal supplementation, but as previously stated this is a tricky solution. Culture plays a large role in keeping these athletes safe from their sport. Coaches need to be able to identify the problems and understand their dangers.
Vocal cord dysfunction (VCD) is another health issue that commonly affects females who are active during puberty (Nordiq Canada, 2021). Athletes have trouble breathing, particularly on inhalation, which is key to performance in endurance sports. Many believe this to be exercise-induced bronchospasm (EIB), a type of asthma. However, asthma is trouble exhaling rather than trouble inhaling (Sports Medicine Today, 2021). With VCD, issues can become worse with stress. Athletes are more likely to discontinue their sport if VCD is misdiagnosed as it makes it increasingly difficult to perform well as an endurance athlete.
Both RED-S and VCD can result in performance plateaus, which is what becomes most noticeable to coaches. Performance based indication of an athlete's health can be seriously dangerous to the athlete’s success in sport and health. It is known that RED-S can affect performance in many ways. The British Journal of Sports Medicine states the common performance indicators of an athlete with low energy availability are “decreased training response, impaired judgment, decreased coordination, decreased concentration, irritability, depression, and decreased endurance performance” (Ackerman et. al, 2019). All of these indicators could cause athletes to become frustrated, especially if they are misdiagnosed and are being pressured by coaches to improve. Two Norwegian case studies discussed how elite athletes felt their perception of the lack of long-term development stemmed from injuries provoked by overtraining (Kristiansen, 2012). The issue was rooted in coaches' pressure, inexperience, and communication. Performance plateaus or decreases are common in both male and female athletes, but it is the lack of adequate solutions for female runners that is problematic. With all of these negative factors for female athletes, one might believe it is impossible to perform like men in sport. However, these are all a result of poor knowledge of female physiology, in athletes and coaches. This creates a culture that makes female athletes more susceptible to health issues. Research shows that optimal energy supply and proper body weight can allow for high performance athletes to maintain high training volumes and reach the limits of peak performance. As well, some athletes might see performance increase while suffering from RED-S, due to lower body weight and a higher tissue stiffness (Wasserfurth et. al, 2020). This however, is not a sustainable position for athletes and will eventually lead to severe health problems or injury. It is essential that coaches understand that RED-S can come with decreased, plateaued, or increased performance. However, plateaued or decreased performance could be indicators of health issues like RED-S or just generally low energy intake, such as eating disorders. This must be addressed before athletes or coaches become distressed with lack of performance. If an athlete feels as if she is not performing well, or her sport is causing her serious health issues she may lose interest in continuing sport. The need for education and identification of all issues female endurance athletes are presented with is essential for athletes safety, participation, and success
Identification of Dangerous Coaching Methods
Alberto Salzar was berated for the way he treated his athletes like Mary Cain. He was known to make disparaging remarks, put high pressure on athletes, and focus highly on body weight. Yet he was able to be in a position to coach the most elite athletes in running under the biggest name in sport, nike. If coaches at the highest level are able to have these methodologies, then what are coaches across the sport doing to their athletes as well? The most commonly reported issues in coaching of female athletes is focusing too heavily on athletes weight or body aesthetics, lack of nutritional support and education, and giving athletes training volumes and methods the same as males.
In a New York Times report on the disaster following Mary Cain’s exposé of the Oregon Project, world class running athlete Kara Goucher states…
“When someone proposes something you don’t want to do, whether it’s weight loss or drugs, you wonder, ‘Is this what it takes? Maybe it is, and I don’t want to have regrets.’ Your careers are so short. You are desperate. You want to capitalize on your career, but you’re not sure at what cost” (Cain, 2019).
This deep quote made many of the sport world wonder just the extent female runners are taking to make it to the elite. Athletes like goucher are under constant pressure, from themselves, coaches, and media to keep body weight in their control. Another olympic athlete, Amy Yoder, shares on social media that she was berated for having “had the biggest butt on the starting line” (Yoder, 2019). All of these comments go into an athlete's psyche. Constantly they remember to keep their body in line, and the resulting methods are almost always dangerous to their health. One of the most common methods to watch body composition is frequent weigh-ins. These were done by Salzar’s Oregon Project Team, and even worse, weigh-ins were performed in front of the whole team. A study in the Psychology of Sport and Exercise journal found that coaches of youth female runners placed a high level of importance on weight for performance, and an “ideal” female athlete body (Carolyn et al., 2014). Coaches should not put emphasis on athletes weight or body composition without any sort of healthy and knowledgeable solution to follow. As well, many coaches are unaware of actual research on why low body weight results in better performance, and gained this mindset from culture and “experience”. The effect these comments have on an athlete's physical and mental health seem to be lost, and body shaming is perceived as just part of the sport.
Eating disorders are rampant in female endurance athletes. A recent study found that almost 1/5 of female junior Norwegian cross country skiers had some form of disordered eating (Nordiq Canada, 2021), and nearly 50% of athletes involved in sports that emphasize a lean body shape and low weight, such as track and field, have been reported to present with features of disordered eating (Torstveit, Rosenvinge & Sundgot-Borgen, 2008). This is due to the nature of the sports emphasis on lean body mass, as well as social pressures from coaches, teammates, and media. A 2012 study on track and field coaches found that many coaches have difficulty in identifying the signs of eating disorders in their athletes. As well, they put little emphasis on the importance of eating adequate amounts (Plateau, 2012). The study also stated many coaches became aware of athletes putting in high amounts of effort to mask eating disorders in order to appear fine to coaching staff. In order to stop this epidemic of eating disorders in endurance sports, coaches must be educated and highly willing to discuss important nutrition. A recent study on low energy availability in both genders, suggests coaches teach athletes flexible eating behavior. This appreciates the importance of a nutrient-dense diet, while not putting labels such as good or bad on food groups. This is stated to support psychological and physiological health in the long run (Wasserfurth, 2020). Coaches must also know their limits with eating disorders. Coaches are not trained nutritionists or doctors, eating disorders are real diseases and should not be treated with coaching advice. It is important that coaches get athletes real professional help with their disordered eating. Adequate knowledge of nutrition was found in only 35.9% of coaches, 71.4% of ATs, 83.1% of Strength Coaches, and a mere 9% of athletes (Torres-McGehee, 2012). Athletes have a large amount of misinformation and stigma surrounding knowledge of adequate nutrition (Wasserfurth, 2020). As well, Sport nutrition is known professionally as different as a regular every-day diet. This confuses a lot of athletes and coaches. For example, sugar is commonly discouraged in a healthy diet, but athletes with endurance workouts rely on simple sugar to fuel their muscles for activity. As well, there is serious misinformation on an athlete's carbohydrate intake in many coaches and runners (Torres-McGehee, 2012). Most of these nutritional problems fall in the hands of coaches. But, it is important athletes are responsible for not denying issues and reporting peer issues. This may only be feasible however in a culture that is supportive and open about nutrition and eating disorders. They should never be considered a taboo, especially since an athlete’s health depends on it.
Female athletes are not male athletes. As gender lines are blurred through the development of more genderless sport, it is important that coaches stay educated on how to train different sexes. In the younger developing athletes, girls and boys have very different progression in performance. Puberty is extremely important in considering differences in sexes. It is natural for young females to gain weight in puberty and experience performance changes (Nordiq Canada, 2021). Muscle development can be very different from peers, which could cause worse performances in comparison to others at different stages. This will also potentially lower self-esteem in young athletes, but reminders of natural differences in puberty can help reduce this. The New York Times by Mary Cain discussed how one of the major problems is that “women and girls are being forced to meet athletic standards that are based on how men and boys develop” (Cain, 2019). Coaches must adapt training and racing to give girls time to maximize their changing bodies (Nordiq Canada, 2021). Besides the difference in adolescent athletes, the sexes differ in adulthood as well. This problem stems from most research and historical methods on improving runners performance came from male athletes. A prevalent issue in distance running is male coaches giving female athletes the same training volumes and routine as men. Female athletes are different in their physiology as stated in the many previous issues above. Researchers state how female athletes are not smaller male athletes and this should be considered as one of the key training considerations (Pitchers, 2019). Coaches who lack the understanding of female physiology risk the development of injuries when giving them similar training to men. The issue comes in as coaches give certain volumes to female athletes at times where they would not be helpful to their performance. This would be when the athletes are suffering from body weight issues, or energy deficiencies. More research is needed on the best methods for coaching female runners in comparison to male athletes. What is most important is to allow female athletes to express their concerns without comparison to male counterparts.
Solutions to the Dangerous Culture
With all of the health issues being seen in female athletes and the dangerous methods found in coaches, is it better to just say women are not meant for endurance sports? The large amount of problems in endurance sports for women make it difficult for the general public to perceive women as just as capable as men. However, the logic is cyclical. The sport was designed for men and it was not until recent years that women were seen as even capable of endurance running. Women have done amazing things in endurance sports, and they will continue to flourish as long as they are not forced into a culture made for and designed by males. It is important that culture is created to support women as openly as men are supported. All of these problems are issues because of culture and lack of knowledge. Solutions will come as research increases and coaches are given adequate education. Having standards in place for coaches of both genders is important in keeping athletes safe and performing properly. As well, an argument can be made that increasing the presence of female coaches could reduce these.
Research is the solution to every problem in the world of science. Having more research on things like RED-S and eating disorders in sport could seriously improve education. But research is just one step. Educating coaches and coaches educating athletes is the only way the research will be effective in solving the problem. Having a standard set in place for coaches could be life changing for athletes. Canada is known for their higher standards of qualifications in coaches. Having coaches who will coach female endurance athletes take specific certifications could really improve the state of health issues among athletes. Besides the strict facts, stigma around female issues must be demolished. Coaches should feel open about discussing these important health issues with their athletes, especially when it comes to socially taboo topics like menstruation. This taboo is dangerous for athletes, amenorrhea should never be a hushed topic in sport. As well, coaches' positions of power should not be abused in order to make athletes fit their physical standards. In the case of Mary Cain, she feared speaking out on her coach which she began to admire greatly, despite his coaching methods destroying her physical and mental health. Safe report outlets should be made for all athletes when they feel endangered by coaches. A routine check-in by an educated governing body could also eliminate bad eggs throughout sport programs. This would replace a system where investigations are only done when problems are reported. This system is extremely ineffective especially in programs mostly for adolescents who are much less likely to report. This is similar to the problem that has been found rampant in the sport of gymnastics. These problems should be kept in the forefront of the media. Cases like Mary Cain should not get lost in the shuffle.
Women are in the minority of coaches for female sports. After the passing of title IX in 1972, women coaching went from 80 to 90 to only 35-42 percent within fifteen years (Sage, 2019). An article in the Guardian quotes Hogshead-Makar, an olympic runner, stating that “more female coaches, the sport could better cope with the high rate of eating disorders and body image issues, which tend to be more common on women’s teams” (Strout, 2018). This is a prevailing ideology in a lot of female athletes, that more women coaches could result in better culture around female specific health issues. However, multiple research shows that female athletes do not prefer female coaches over males. The preference is hard to determine, and it would be hypocritical to state that one gender should coach another. Having more female coaches could help improve the culture of female sport, but if those female coaches get their methods from research and education that is meant for men the cycle continues. Overall, The problem is not necessarily an issue of male coaches but lack of knowledge in all genders about female health problems. The assumption is that women know more about women's problems than men, which is mostly true. Making a culture more inclusive for all genders is going to be a better solution than pressing the replacement of male coaches with female coaches.
Conclusion
In order to keep female endurance athletes safe in sports, more education is needed in training and coaching methodologies. The current coaching culture for young female endurance is perpetuating health problems throughout all levels of performance. The athletes in endurance sports are suffering from a range of complications like relative energy deficiency in sport, disordered eating, vocal cord dysfunction, and body image issues all which can result in declining or plateaued performance and lack of interest in sport. Coaches have been exacerbating the problem by focusing on athletes' appearances, enhancing nutritional deficiencies and training women in the same ways as men. All of these methods are a result of education being based in coaching male athletes and little knowledge of females. The problem can be slowly fixed by increasing the research and funding of female endurance athletes training and coaching methodologies. As well, adequate education of coaches and consequently of their athletes is essential. An introduction of certification for coaches and evaluation of program methodologies could better protect athletes. Female endurance athletes are some of the most determined and impressive athletes in sport. Keeping these women safe from the toxic culture destroying their health is the responsibility of society.
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